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        <p>第50章 续5<br>器械研磨（Instrument Sharpening)<br>锐利的器械比钝的器械切割更精确更快速。使用钝的器械要比使用锐利的器械握得更用力，压力也要更大才行。这降低了手感，有可能导致打滑。因此，要避免浪费时间和随意操作，医生必须完全的熟悉器械磨光的原则，并能运用它们以达到在器械的工作端上产生一个锋利的边缘。(Therefore, to avoid wasting time and operating haphazardly, clinicians must be thoroughly familiar with the principles of sharpening and able to apply them to produce a keen cutting edge on the instruments they are using.)这需要耐心和练习。<br><strong>评估锋利度</strong><br>器械的切割边缘由刃上的两个成角度的面接合而成。如刮治器的切割边缘由上面（face surface)和侧面组成。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/01.jpg"><br>如果器械是锋利的，接合处是一条沿着切割边缘长度走行的平缓的直线。在使用中，金属会磨耗，上面和侧面的接合处会变圆或者变钝。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/02.jpg"><br>因此切割边缘会变成一个圆钝的表面，而不是一个锐利的角，导致器械的切割效率降低，需要在工作时使用更大的力量。<br>用视觉和触觉来评估器械的锐利程度的方法：<br>①当在灯光下向下握持一个钝的器械时，圆钝的切割边缘会将光线反射回观察者。在切割边缘的接合处出现一条亮线。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/03.jpg"><br>相反的，对于锐利器械的切割边缘，没有表面会反光。当如上握持时，锐利器械看不到亮线。<br>②触觉检查通过将器械轻轻划过一个丙烯酸树脂的棒（税利测试棒，sharpening test stick)，钝的器械可以光滑地滑过，而不会咬入棒中并产生轻微的划痕，而锐利的器械会。<br><strong>研磨的目的</strong><br>恢复一个平整的，薄的，线性的切割边缘。通过研磨刃的表面，直到其接合处达到一个锐利的角而非圆钝的角。重要的是保持原来的切割边缘的形态，不改变角度。如果改变了角度，器械的使用方式就不是其原来设计时的那样了，这会降低工作效率。<br><strong>磨石</strong><br>可以是天然矿物或者人工制造的。其表面为比要研磨的器械的金属硬的摩擦晶体。粗糙的晶体的颗粒更大，切割效率更快。用在钝的器械上。细腻的磨石的颗粒更小，切割更慢，用在最终的研磨以产生一个平缓的边缘。（跟研磨修复体是一个道理：用来磨的东西要比被磨的东西硬）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/04.jpg"><br><strong>研磨的原则</strong><br>①选择磨石或研磨卡片，有适当的形状和粗糙度（abrasiveness）。<br>②将研磨器械灭菌，一人一用。<br>③在研磨器械和要研磨的器械之间建立正确的角度，这以理解器械设计的原理为前提。<br>④用一个稳定的，有力的力量握持研磨器械和被研磨的器械。这保证在整个研磨过程中角度的稳定性。用这种方法，器械的表面可以被均匀地磨除，而不产生不恰当的斜面。<br>⑤避免过度用力。大的压力会导致磨石表面被磨耗得更快，不必要的降低了器械的使用寿命。<br>⑥避免形成“丝状边缘”(wire edge)，就是在磨好的切割边缘形成细微的粗糙的丝状金属扩展（类似与肩台的飞边之类的吧。）其会在牙根表面产生更大的蚀刻。产生丝状边缘的原因，是研磨用力地方向是远离切割边缘，而不是进入或靠近。当用后-前或者上-下的力时，可以用一个向下的力完成研磨来避免形成丝状边缘。（用力方向是从切割边缘接合处向刃的两个面扩展，而不是相反，向接合处集中。）<br>⑦当用磨石时，在研磨时要加润滑剂。这能减少摩擦表面被研磨下来的金属碎屑所阻塞。这也减少了摩擦产热。<br>⑧在器械看起来钝了的第一时间就研磨器械。非常钝的器械会降低工作效率，另外研磨它也需要磨除更多的金属。这会降低器械的使用寿命。<br><strong>各种器械的研磨</strong><br><strong>通用刮治器</strong><br>有很多技术使用。不管使用何种技术，医生必须注意保持刃的上面(face surface)和侧面(lateral surface)的角度是70-80°。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/05.jpg"><br>这是进行龈下刮治和根面平整术最有效的角度。<br>改变这个角度会破坏器械的设计，导致效率降低。小于70°的角度很锐利，但是也很薄。其磨耗很快，然后变钝。超过90°的角度需要更大的侧向压力。用这样的器械清除牙石往往不彻底，也不能有效进行根面平整。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/06.jpg"><br>建议使用如下技术：<br>研磨侧面：当正确放置磨石和器械时，刃的上面与磨石之间的角度是100-110度（见前一张图）当刃的上面与地板平行时能更好的看出来。用手掌握持器械，用前臂对抗身体做支撑。<br>①将磨石放于刮治器的侧面，使刃的上面与磨石呈100-110度角。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/07.jpg"><br>②从柄的切割末端开始，在尖端附近研磨，用上下的力移动磨石。使用持续的，轻的压力保持磨石与刃持续接触。确保角度保持在100-110度之间。<br>③用前述方法检查锐利度，如果需要，继续磨。为了避免使器械尖端变成一点，研磨从短柄到尖端的整个刃。当到达尖端时，确保保持其圆钝的形态。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/08.jpg"><br>④当磨石沿着切割边缘移动时，用向下的力完成每个部分，避免形成丝状边缘。在灯下检查切割边缘。<br>⑤用这种方法倾向于使侧面变平。这可以在研磨完成后，轻微摩擦侧面和背面。<br>⑥当磨完一个边缘以后，用同样的方式磨另一边。<br>研磨上面：用一个圆柱形或圆锥形磨石前后运动。也可以用安在机头上的，但不建议，原因如下：<br>①器械与磨石之间的角度很难保持，可能导致不恰当的斜面出来。<br>②从前往后磨。这会损伤刃并使其易弯或者折断。<br>③用手持磨石从后往前磨，会造成一个丝状边缘妨碍刃的锐利度。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/09.jpg"><br><strong>特定牙位专用(Gracey)刮治器</strong><br>像通用刮治器一样，Gracey刮治器同样在刃的上面与侧面之间有一个70°-80°的角度。因此上面所说的技术同样可以用于Gracey刮治器的研磨。但其设计与通用刮治器设计的不同需要充分理解以避免破坏了其设计。<br>Gracey刮治器有补偿的工作刃，即刃的上面与器械的柄之间的角度不是90°（垂直的），而是呈70°。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/10.jpg"><br>Gracey刮治器同样有两个切割边缘，但只有矮的那边是用来进行刮治和根面平整的。因此也只有这边需要研磨。<br>当刃的上面与地面平行，从上往下看时，切割边缘是沿直线扩展的。与此对比，当用同样的方式看Gracey刮治器时，切割边沿从它们的短柄那里开始出现，形成一个弯曲。这在13-14号刮治器上最明显，而在前牙如1-2号刮治器上不明显。对于所有的Gracey刮治器，工作端的切割边缘在刃的中和尖1/3端变直了，形成一条直线，直到在器械的尖端再次弯曲。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/11.jpg"><br>(看图，右侧的外面大弧是工作侧。）<br>用以下方法研磨Gracey刮治器。<br>①握持刮治器，使其刃的上面与地板平行。由于刃是有补偿曲线的，器械的柄不会与地板垂直。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/12.jpg"><br>②辨认出需要研磨的边缘。记住只需要研磨工作侧。用磨石或磨卡接触侧面，使刃的上面和磨石呈100-110°（跟通用刮治器一个道理。）<br>③用短促的上下方式用力，从刃的柄的末端到弯曲的尖端，以向下的力结束用力。<br>④尽管切割边缘在接近柄的那端是弯曲的，工作部分的中部和尖端实际上是直的。记住保持刃的原始轮廓。如果磨石在一个地方长时间用力，刃会变平（如下图左边）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0070-lcyzbxbj12/13.jpg"><br>⑤用前述的方法评估锋利度，如果需要的话继续研磨。<br>(其它器械的研磨方法略了，用到了再说。总结一下，就是注意研磨的时候不要改变其角度，一般是70°-80°，这样磨石与刃的上面的角度就是100-110°，另外注意用力方式，应该是从边缘往刃中间用力，否则可能产生飞边。）</p>
<p>这一章终于完了。这是2019年的第一篇推送/博文，希望新的一年大家都越来越好吧。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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